Suburban ambulance companies struggle to stay afloat

BERWYN, Pa. (AP) — Keith Johnson could tell story after story about the vitriol he's faced as EMS chief of Malvern Fire Company.

"I had a gentleman literally in one breath thank me for my crew saving his daughter's life," he said, "and in the second breath say: 'But your bill's ridiculous, I'm not paying.'"

In Berwyn, Fire Chief Eamon Brazunas has gotten scathing notes from folks upset about their ambulance bills because they wrongly assume that the service is free for taxpayers.

In fact, ambulance companies throughout the suburbs rely on billing, donations and limited municipal support. Now, with their budgets increasingly strained, fire and EMS squads across the region are reaching out to the residents in their coverage areas, not to raise money or recruit volunteers, but to educate.

Through the end of June, Berwyn Fire Company is holding several town hall meetings. Other agencies, such as Good Fellowship Ambulance Company in West Chester, will host open houses later this month during National EMS Week.

Emergency responders are especially worried now, a year after a statewide report declared a "public safety crisis," at a time when ambulance providers are struggling more than ever to stay afloat.

"We're actually beyond crisis mode," said Beau Crowding, deputy director of the Chester County Department of Emergency Services and one of 39 Senate commission members to work on the report.

With fewer volunteers, the modern EMS system is strained by an aging population (by 2025, more than one in five Pennsylvania residents will be 65 or older), more senior living facilities, the opioid crisis, and the rising cost of equipment. They struggle to get paid for many calls because commercial insurance companies send reimbursement checks directly to patients for out-of-network service.

In the state's fastest growing county, fire and EMS services are especially stressed. While the volunteer firefighting crisis grabs many of the headlines, the EMS side of the equation is in trouble, too, perhaps even more so. Ambulance calls come in more frequently than fire calls — and are more often life-threatening, said Kimberly Holman, executive director of Good Fellowship Ambulance, who also was on the state report commission.

In a boardroom at Good Fellowship on a recent day, Chester County EMS leaders stressed that they didn't want to worry residents. An ambulance will still show up if you call 911.

It's just a question of how long it will take to get there, and how much some homeowners might have to pay in the future if volunteer services have to become fully paid. Nationally, towns that rely on volunteers save almost $47 billion a year.

Of the 30 EMS stations in Chester County alone, most rely partly or entirely on volunteers, many of whom are cross-trained firefighter-EMTs. Several companies are 100 percent volunteer. Squads are used to backing each other up, running to calls in jurisdictions outside their own if one crew is busy.

"We have managed as a service to survive, because we figure out how to make it work,"said Gary Vinnacombe, who serves as executive director of Trappe Fire Company, EMS manager at West Grove Fire Company, and president of the county's EMS Council. "The problem is we've been so good at that. We're at a point where it's going to break soon. And when it breaks, I don't know what's going to happen."

Decades ago, towns were more "community-based," Holman said, and more residents knew their ambulance companies.

"Now you have a much more transient population," she said. "They don't worry about learning the EMS system because they'll probably only be here three, four, five years"

Rich Constantine, Malvern Fire Company's deputy EMS chief, put it more bluntly: When more residents were entrenched in the community, "they knew you needed money. They don't know that now."

County officials note that suburbanites say they prioritize public safety, yet many don't know which agency provides their EMS service, let alone how that agency is staffed and funded.

"Most citizens think their tax dollars go to pay for fire and EMS service," said Chester County Commissioners' Vice Chair Kathi Cozzone. "Anecdotally, providers are trying to do more and more communication with the public to increase education about how they're funded."

The cost of ambulance service varies based on a number of factors, including location, but can be as high as thousands of dollars. When bills arrive, some patients refuse to pay, bemoaning the cost or assuming the service will survive regardless, EMS leaders said.

Some also cash checks from their private insurers, checks that are meant to be forwarded along to an EMS agency to pay for ambulance service. Every year, Holman said, Good Fellowship expects to receive about half of what is billed through commercial insurance companies (Medicare and Medicaid payments also come in, but they represent only a fraction of the cost of services).

Municipalities are doing what they can, emergency officials say.

West Goshen Township has dramatically increased contributions to the fire and EMS stations that serve its residents, said township manager Casey LaLonde. Those stations include Good Fellowship Ambulance, to which LaLonde said the township this year increased its annual support to $25,000 from $6,000, the standard township contribution for years.

"They provide excellent service," LaLonde said of the agency, "but I don't think our residents understand how expensive it is."

Soon, however, municipal support may not be enough, officials say.

"The service needs to be provided," said Cozzone, also a board member at Uwchlan Ambulance Corps. "So if it can't be provided at the local level, I think municipalities are going to look to the county to either pick up the tab entirely, or help the municipalities in some way be able to afford it."

Chester County has already shelled out nearly $100 million over the last five years for public safety, she said.

Across the region, ambulance companies have closed and others have merged.

In densely populated areas, residents might not feel the effect of a merger or closure, officials said. But in remote areas, the impact could be serious.

In Hazleton, Luzerne County, where backup ambulances often have to travel long distances, residents have reported wait times of half an hour or more.

As officials work to keep services intact in Chester County, some municipalities, such as West Brandywine Township, have enacted a fire services tax.

Linda Crownover, 65, of Chesterbrook, said she'd be up to pay one, too, if it helps her EMS provider, Berwyn Fire, stay alive.

"We're placing more and more demands on our services and someone's going to pay for it," she said. "I think it should be us."